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Neurologic Exam Flashcards

1
Q

Neurologic Exam Components

A
  1. Mental Status
  2. Cranial Nerves
  3. Motor Examination
  4. Reflexes (DTRs, Pathological)
  5. Coordination and Gait
  6. Sensory Examination
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2
Q

Neurologic Exam Descriptions

A

• Tests function

• Each part is used to titrate the patient’s level of function

• Flexible and SHOULD be tailored to clinical situation
• May be done in greater or less detail depending on the clinical suspicion
• Certain parts can be combined or performed in a slightly different order to minimize the number of times the patient needs to change positions

• Screen for unsuspected lesions and to test hypotheses for localization

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3
Q

Mental Status =

A

Cerebral Examination

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4
Q

3 global brain function which determines how well we can perform the neurologic exam

A

-Level of alertness
-Attention
-Cooperation

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5
Q

Other components of mental status

A

• General behavior and appearance
• Orientation
• Memory
• Language
(left hemisphere dominant)
• Calculation
• Neglect and constructions (parietal obe)
• Sequencing tasks and frontal release signs frontal lobe)

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6
Q

Language is dominant on

A

Left hemisphere

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7
Q

Neglect and constructions is dominant on

A

Parietal lobe

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8
Q

Sequencing tasks and frontal release signs are dominant on

A

Frontal lobe

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9
Q

MMSE - P Description & Components

A
  • Mini-Mental Status Examination -PH
  • Over 30, 1pt each
  • DSP - <27

Components
- Orientation to time and place
- Registration
- Attention & Calculation
- Delayed Recall
- Language
—Naming, Repetition, 3-step command, reading comp, writing, copying, & vision-spatial function

-for cerebrum capacity

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10
Q

MOCA-P

A
  • Montreal Cognitive Assessment - Philippines

• TOTAL SCORE: Sum of all subscores listed on the righthand side. Add one point for an individual who has 12 years or fewer of formal education, for a possible maximum of 30 points.

• A final total score of 26 and above is considered normal
DSP - 21

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11
Q

Testing for the level of alertness, attention, and cooperation

A

Focus on a simple task
• Spelling a short word forward then backward
• Repeat a string of numbers forward and backward (digit span)
• Normal digit span is 6 or more forward and four or more backward
• Naming months forward and backward
• Twice a long to recite months backwards

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12
Q

Usual cause for problem with the level of alertness, attention, and cooperation

A

• Brainstem reticular formation
• Bilateral lesions in thalami or cerebral hemispheres
• May be mildly impaired in unilateral cortical or thalamic lesions
• Encephalopathies
— Hepatic Encelopathies
• Behavioral and mood disorders

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13
Q

Test for orientation

A

• Person
• Place
• Time
• Document specifically the questions they were asked and how they were answered
• Detect changes throughout time
• Tests recent and longer-term memory

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14
Q

giving the patient several words to remember and testing for recall 4-5 mins later

A

Recent memory

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15
Q

verifiable personal information

A

Remote memory

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16
Q

Testing the recent memory

A

• Recall 3 items after a delay of 3-5
mins
• Make sure there is registration by asking to repeat it immediately before initiating the delay
• Provide distractions during the delay to prevent from rehearsing

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17
Q

Testing remote memory

A

• Historical or verifiable personal events

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18
Q

Impaired registration / immediate recall =

A

Impaired attention = impaired reticular formation or cerebrum

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19
Q

Impaired delayed recall =

A

Impaired medial temporal lobes and medial diencephalon

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20
Q

Composition of language

A

Spontaneous speech
Thinking
Comprehension
Naming
Repetition
Reading
Writing

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21
Q

Fluency, abundance, content, tonal modulation, grammar

A

Spontaneous speech

** cerebellum for tonal modulation and grammar

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22
Q

inappropriate substitution of words or syllables

A

Paraphrased errors

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23
Q

form and content

A

Thinking

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24
Q

Simple questions and commands

A

Comprehension

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25
Q

Easy and hard to name objects

A

Naming

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26
Q

Repeat single words and sentences

A

Repetition

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27
Q

Read and test for comprehension

A

Reading

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28
Q

Broca’s area and wernicke’s area are dominant on

A

Left cerebral hemisphere

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29
Q

Broca’s area is responsible for

A

Motor speech
Speech production

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30
Q

Wernicke’s area is responsible for

A
  • speech comprehension
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31
Q

prevents a person from producing speech
person can understand language
words are not properly formed
speech is slow and slurred.

A

Broca’s aphasia

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32
Q

loss of the ability to understand language
person can speak clearly, but the words that are put together make no sense. This way of speaking has been called “word salad” because it appears that the words are all mixed up like the vegetables in a salad.

A

Wernicke’s aphasia

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33
Q

Connection between broca’s and wernicke’s

A

Arcuate fasciculus

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34
Q

Inability
carry
out an action in response to verbal command, in the absence of any comprehension deficit, motor weakness or incoordination (an activity that can be performed well spontaneously)
• Inability to formulate the correct movement sequence
• Pretend to comb your hair, brush your teeth, strike a match and blow it out
• Lesion in dominant
temporoparietooccipital area

A

Ideomotor apraxia

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35
Q

Ideomotor apraxia is a lesion dominant on

A

Temporoparietooccipital area

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36
Q

abnormality in attention to one side that is not due to a primary or secondary sensory or motor disturbance
• Extinction on simultaneous double extinction
• Prone to injury and falls

A

Hemineglect

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37
Q

L hemineglect is a lesion on the

A

R parietal lobe

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38
Q

Test for hemineglect

A

-Neglect drawing test
-Visual Extinction
-Tactile Extinction
-Copy drawing

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39
Q

difficulty in changing from one action to the next when asked to perform repeated sequence of actions

A

Preservation

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40
Q

tap table with fist, open palm, side of open hand then repeat

A

Luria manual sequencing tasks

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41
Q

Frontal release signs

A

Grasp
Snout
Rooting reflex

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42
Q

Motor execution is dominant on

A

Precentral gyrus

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43
Q

Planning is dominant on

A

Premotor cortex

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44
Q

Abstract reasoning, judgement, and logic is a dysfunction on

A

Frontal lobe

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45
Q

Fixed belief

A

Delusions

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46
Q

Fixed belief

A

Delusions

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47
Q

Inability to understand meaning, import or symbolic significance of ordinary sensory stimuli even though the sensory pathway and sensorium are relatively impact

A

Agnosia

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48
Q

Inability to recognize letters/numbers traced on the palm

A

Agraphesthesia
Agraphognosia

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49
Q

Inability to recognize face but recognize the voice and can describe the parts

A

Prosopagnosia

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50
Q

Lack of awareness of body defect

A

Anosognosis

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51
Q

Abnormal perceptions

A

Hallucinations

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52
Q

Diffuse brain dysfunction
• Psychiatric disorders

A

Delusions and Hallucinations

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53
Q

Disturbance in neurotransmitters

A

Mood

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54
Q

Signs of depression, anxiety, mania
• Congruence
• Psychiatric in origin
• Biochemical/neurotransmitter imbalances
• Somatization and conversion disorders

A

Mood

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55
Q

Nonexistent words

A

Neologism

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56
Q

Testing the CN 1

A
  • Olfactory n./ Olfaction
  • coffee grounds
    beans
    -Noxious odors may stimulate pain fibers of CN V
  • One nostril at a time
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57
Q

Problem may be d/t

A

Nasal obstruction, damage to olfactory nerves in the mucosa, as they cross the cribriform plate, or intracranial lesions affecting the olfactory pathway

Parkinson’s disease
- anosmia is one of the nonmotor symptoms

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58
Q

Visualization of the retina, retinal vessels, optic nerve atrophic changes, papilledema

A

Opthalmoscopy

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59
Q

Test for visual acuity

A

Snellen Chart
- test one eye at a time

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60
Q

Test for color vision

A

Ishihara test

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61
Q

Test of visual fields

A

fixate on the
examiner’s nose and report when a finger can be seen moving in each quadrant or how many fingers are held up

  • Blink to threat for stroke
  • Perimetry - blinking lights machine
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62
Q

double simultaneous stimulation

A

Visual extinction/hemineglect

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63
Q

Visual hemineglect

A

contralateral parietal lesion: more robust when on the right

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64
Q

Pupillary Light Reflex (PLR)

A

CN II (Optic Nerve) and CN III (Oculomotor
Nerve)

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65
Q

Pupillary Light Reflex (PLR) Types

A

Direct pupillary light reflex
—ipsila cn ii

Consensual pupillary light reflex
—contralat cn iii

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66
Q

Near response

A

Accomodation

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67
Q

Accommodation is the convergence by

A

Medial recti

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68
Q

Pupillary constriction by

A

pupillary constrictor muscles of the iris

Iris sphincter

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69
Q

Lens thickening by contraction of the

A

Ciliary muscles

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70
Q

Testing for for cn iii, iv, vi

A

-Extraocular muscles

• Observe for dysconjugate gaze, spontaneous nystagmus
• Look in all directions without moving head
• Ask for double vision

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71
Q

check full range of horizontal and vertical eye movement

A

Smooth pursuit

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72
Q

Rapid fixation

A

Saccades

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73
Q

Cn v general sensation

A
  • Facial Sensation and Muscles of Mastication

-light touch, pinprick on all divisions of trigeminal nerve

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74
Q

Tactile extinction

A

R parietal lesion

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75
Q

Afferent corneal reflex

A

Cn v

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76
Q

Efferent corneal reflex

77
Q

What to inspect and palpate for cn v

A

Masseter and temporalis

78
Q

Jaw jerk reflex

A

• Sign of hyperreflexia associated with UMN lesion to trigeminal motor nucleus
• Afferent and efferent limbs: CN V

79
Q

Impaired facial sensation and muscles of mastication

A

lesions of CN V, trigeminal nuclear complex in brainstem, thalamus, somatosensory cortex

lesions of the UMN
That synapses with trigeminal motor nucleus,

LMN of trigeminal motor nucleus to peripheral nerve, NMJ, muscle

80
Q

Cn vii observation

A

Asymmetry, depth of nasolabial fold (NLF), spontaneous facial expressions, blinking
• Compare with old photo

• Smile, puff cheeks, close eyes tightly, wrinkle eyebrows

• Taste in(anterior 2/3)of tongue

81
Q

Screening for cn viii

A

Finger rubbing
• Whispered words
• Ticking of watch

• Weber’s
• Rinne’s

82
Q

Benign paroxysmal positional vertigo

A

Dix-Hallpike Maneuver

83
Q

unilateral hearing loss is d/tv

A

lesions in the ear, cochlea, CN VIIII

• Enter the brainstem and cross over at multiple levels and ascend bilaterally to thalamus and auditory cortex

84
Q

Weber’s test

A
  • Place a vibrating tuning fork (256Hz or 512Hz) on the vertex of the skull in the midline
    • N: pitch heard equally on both ears

Conductive: louder on affected side (conduction through skull louder)
• Sensorineural: softer on affected side

85
Q

Rinne’s test

A

Vibrating tuning fork placed on patient’s mastoid then next to the
ear
• Air conduction is compared to bone conduction in each ear
• N: sound next to ear should be louder because it takes advantage of the middle ear bone amplification
• АС>ВС

Conductive: middle ear bones are not working normally or sound cannot access the middle
ear = softer next to ear
• ВС>АС
• Sensorineural: AC>BC but decreased in affected ear

86
Q

Palatal Elevation and Gag Reflex

87
Q

Impaired palatial elevation and gag reflex

A

Lesions of cn ix, x, nmj, pharyngeal muscles

88
Q

Palatial elevation observation

A

Symmetrical palatal elevation when the patient says “aah”

89
Q

Gag reflex observation

A

Gag when posterior pharynx is brushed - only tested in suspected brainstem pathology, impaired consciousness or impaired swallowing

90
Q

Muscles of articulation cn

A

CN V, VII, IX, X, XII

91
Q

CN V, VII, IX, X, XII

A

Listen to patient spontaneous speech - hoarse, slurred, nasal, rhythm, volume
• Change from baseline
• Dysarthria - abnormal pronunciation of speech (Slurred speech)
• Aphasia - abnormality in language comprehension or production

92
Q

Impaired articulation

A

Lesions in muscles of
articulation, NMJ, peripheral or central portions of CCN V, VII, IX, X or XII

• Lesions in cerebellun
motor cortex sasal ganglia

93
Q

Cn xi test

A

Shrug shoulders, turn head both sides

94
Q

Can xii observation

A

Observe at rest - muscle bulk, presence of fasciculations (spontaneous, quivering)

• Tongue protrusion - deviations, movement side to side

• Tongue strength - push against inside of cheek

95
Q

Signs of lmn lesions of the tongue

A

Fasciculations and atrophy

96
Q

Unilateral tongue weakness

A

deviate towards weak side

• LMN - ipsilateral
• UMN - contralateral

97
Q

Motor examination Components

A
  1. Observation
  2. Inspection
  3. Palpation
  4. Muscle tone testing
  5. Functional testing
  6. Strength testing
  7. Presence of involuntary movements
98
Q

Supraspinal neurons and their tracts

99
Q

Anterior horn motor neuron send axons to innervate the skeletal muscles through the anterior roots of the spinal nerves

100
Q

Components of LMN

A

• Anterior horn cell
• Peripheral nerve
• Neuromuscular junction
• Muscle

101
Q

Observation for motor exam

A

Muscle bulk
• Presence of involuntary movements / paucity of movement
• Posture

102
Q

Motor exam inspection and palpation

A

Muscle wasting, hypertrophy, fasciculations

103
Q

abnormal muscle twitching due to spontaneous activity in groups of muscle cells

A

Fasciculations

104
Q

Lmn disorder inspection and palpation

A

intrinsic hand muscles, shoulder girdle, thigh in patients

105
Q

Inspection and palpation tenderness

106
Q

Amount of tension (or resistance to movement) in muscles
• Partial state of contraction at rest
Passive movement of the joints

A

Muscle tone

107
Q

Lmn muscle tone

A

Discontinuation of the afferent or
efferent reflex pathways = loss of muscle
tone = flaccid

• Atrophy, reduced muscle volume

108
Q

Umm muscle tone

A

High resistance to stretch due to
hyperactive stretch reflexes = hypertonic =
spastic

109
Q

Detect subtle abnormalities

110
Q

Test fine movements

A
  • finger tapping
  • rapid foot tapping
111
Q

Muscle strength description

A

Patterns of weakness help localize a lesion
• Compare with contralateral counterpart
• Note pattern of weakness

112
Q

DTR Testing

A

• Limbs relaxed and symmetrical position
• Compare with contralateral side to detect asymmetries

113
Q

DTR Reinforcement procedures

A
  • pull method of jendrassik
    -counterpressure
114
Q

Other signs of hyperreflexia

A
  • Spread of reflexes to other muscles not directly tested
    • Crossed adduction of opposite leg when medial aspect of knee is tapped
    -hoffman’s and tromner’s
115
Q
  • babinski
A

downward contraction of toes

116
Q

+ babinski sign

A

upgoing big toe and fanning of other toes with or without triple flexion reflex (ankle dorsiflexion, hip and knee flexion) = umn

Silent/mute compare w/ contralat side

117
Q

Move an object along the lateral aspect of the sole

A

Plantar toe reflex
Babinski

118
Q

Move an object in the lateral side of the foot

119
Q

Squeeze hard on the Achilles tendon

A

Achilles toe reflex
Schaeffer

120
Q

Press your knuckles on the pt’s shin and move them downward

A

Shin-toe reflex
Oppenheim

121
Q

Squeeze the calf muscle momentarily

A

Calf toe reflex
Gordon

122
Q

Make multiple light pinpricks on the dorsolat surface of the foot

A

Pinprici toe reflex
Bing

123
Q

Pull the 4th toe outward and downward for a brief time and release suddenly

A

Toe-pull reflex
Honda, stransky

124
Q

Primitive reflexes

A

Glabellar blink/tap
Snout reflex
Suck reflex
Grasp reflex
Palmomental reflex

125
Q

Glabellar blink/tap

A

• taps glabella rapidly 10x
• N: lid remains open
• Abn: continuous reflex blinking with or without lid closure (orbicularis oculi)

126
Q

Snout reflex

A

With patient’s eyes closed, tap the philtrum
compressing the uppettp ainst the gum
• N: no response
• Abn: puckering or pursing of the lips (orbicularis oris)

127
Q

Suck reflex

A

With patient’s eyes closed, stroke the patient’s lips from center of the crevice to the sides
• N: no response
• Abn: Pursing or sucking motion

128
Q

Grasp reflex

A

Ex uses Index and middle finger to stroke patient’s palm from the hypothenar eminence towards the junction of the index finger and thumb
• N: no response
• Abn: grasping Ex fingers

129
Q

Palmomental reflex

A

• Stroke the patient’s hypothenar eminence
• N: no contraction of mentalis muscle
• Abn: ipsilateral or bilateral mentalis contraction

130
Q

Superficial Reflex

A

Bulbocavernosus
Anocutaneous
Cremasteric
Abdominal/bervor’s

131
Q

pricking the glans bulbocavernosus muscle, detected by
pressing a finger against the perineum

A

Bulbocavernosus

132
Q

pricking or scratching the perianal skin causes a quick constriction of the anal sphincter

A

Anocutaneous (anal wink)

133
Q

elevation of the ipsilateral testicle in relation to thigh stimulation

A

Cremasteric

134
Q

normal. response is the umbilicus twitches toward the quadrant stimulated

A

Abdominal/ beevor’s

135
Q

Ataxia

A

Lack of order

abnormal movements in coordination disorders

• Appendicular ataxia
-ipsilat cerebellum

• Truncal ataxia
- cerebellum vermis

136
Q

Test for appendicular ataxia

A

• Rapid alternating movements = dysdiadochokinesia
• Finger-to-nose test = dysmetria
• Overshoot
• Finger tapping test
• Heel-shin test
• Foot tapping
• Ipsilateral limb intention tremor
• Ipsilateral limb ataxia

137
Q

cerebellar vermis
• Wide based, unsteady, drunk like gait
• May have difficulty sitting up without support

A

Truncal ataxia

138
Q

Stand with feet together, eyes closed

Vision, proprioception, vestibular senses
• Eyes closed, instability due to proprioceptive and vestibular systems

A

Romberg Test

139
Q

Coordination and gait observation

A

Stance, posture, stability, how high the feet are raised off the floor, trajectory of leg swing, circumduction, leg stiffness, arm swing, tendency to fall, rate and speed, difficulty initiating or stopping gait, involuntary movements

140
Q

walk in straight line while touching the heel of one foot to toe of the other with each step

A

Tandem gait

  • cerebellum= ipsilat
  • vermis = any of the side
141
Q

Sensations

A

Light touch -
• Pain - pinprick
• Temperature - cool piece of metal ie tuning fork
• 5-10C and 40-45C
• Vibration sense
• Joint position sense
• Two-point discrimination

142
Q

Sensory exam

A

• Performed in all extremities including face and trunk
• Eyes closed
• Reproducible
• Correlate and recheck to improve objectivity

143
Q

Light touch

A

Cotton tipped swab or fine light touch
• Anterior spinothalamic tract

144
Q

Pain

A

Sharp or dull end of a safety pin or broken wooden swab
• Ask patient to identify sharp or dull
• Lateral spinothalamic tract

145
Q

Temperature sense

A

Cold metal ie end of tuning fork
• Lateral spinothalamic tract

146
Q

Vibration sense

A

Low frequency tuning fork 128 Hz on the ball of the large toe or fingers
• Posterior column-Medial
Lemniscal pathway

147
Q

Joint position sense

A

Moving toe or finger up or down
• Posterior column-Medial
Lemniscal pathway

148
Q

Two point discrimination

A

Special calipers or bent paper clip
• Alternately touching with one or two points
• Posterior column-Medial
Lemniscal pathway

149
Q

neither patient nor examiner can flex the patient head because of reflex spasm of nuchal (extensor)
muscles

A

Nuchal rigidity

150
Q

adduction and flexion of the legs as the head is flexed
• Flexion of the neck places tension on the entire cord and roots.
Flexion of the legs reduces stretch on nerve roots

A

Brudzinski sign

151
Q

bent knee leg raising test; knees cannot extend due to pain

A

Kerning sign

152
Q

Approach to neurologic deficit

A

History, Physical and Neurologic Examination
Is this a neurologic problem?
• Focal neurologic deficits
• Increased intracranial pressure
• Meningeal Irritation
Where is the lesion?
What is the lesion?

153
Q

Set of symptoms or signs in which causation can be localized to an anatomic site in the CNS or PNS

A

Focal Neurologic Deficits

154
Q

disturbance in higher intellectual functions

155
Q

cranial nerve deficits

156
Q

weakness or paralysis of extremities

A

Motor pathway

157
Q

incoordination, poor balance

A

Cerebellum

158
Q

asymmetry in DTRs, pathological reflexes

159
Q

sensory impairment

A

Somesthetic system

160
Q

autonomic disturbances (bowel, bladder, sex)

161
Q

autonomic disturbances (bowel, bladder, sex)

162
Q

Intracranial pressure 3 volumes

A
  1. Brain parenchyma
  2. CSF
  3. Blood volume
163
Q

Sum of volumes of brain, CSF and intracranial blood is constant.

An increase in one should cause a decrease in one or both of the remaining 2.

A

Monroe kelly doctrine

164
Q

• Blurred or elevated optic papillae (optic nerve head or disc) resulting from edematous fluid in the nerve fibers as they cross the disc to perforate the cribriform plate and enter the optic nerve
• Transmission of increased ICP into the eye via the subarachnoid space, which extends out along the optic nerve

A

Papilledema

165
Q

Acute + trauma

A

Epidural hematoma
Subdural hematoma
Subarachnoid hemorrhage
Parenchymal hemorrhage

166
Q

Acute - trauma + fever

A

Acute meningitis

167
Q

Acute - trauma - fever

A

Cerebral infarction
Cerebral hemorrhage
Sah

168
Q

Chronic

A

Mass lesion
Chronic meningitis
Hydrocephalus

169
Q

Inc intracranial pressure sx

A

Headache/vomiting with:

a. Papilledema
b. Diplopia with internal squint (lateral rectus palsy secondary to abducens nerve lesion)
c. Decreased level of consciousness
d. Bulging fontanel, separation of sutures, rapidly enlarging head

170
Q

Meningeal irritation

A

Headache/Vomiting with
• Nuchal rigidity
• Brudzinski sign
• Kernig sign

171
Q

Where is the Neurologic Problem?

A

Levelize
• Localize
• Lateralize

172
Q

Seizure
• Language problem (dysphasia/aphasia)
- dominant hemisphere
• Behavioral, personality and mental changes (delirium, dementia)
• Contralateral hemiparesis with Babinski
• Contralateral hemisensory deficit
• Contralateral homonymous hemianopia/quadrantanopsia (visual
field deficit)

A

Cerebral lesion

173
Q

CROSSED MOTOR/SENSORY
SYNDROME
• Ipsilateral cranial nerve deficit
• Do not decussate from the brainstem to the structures that they innervate
• Contralateral hemiplegia with Babinski
• Contralateral hemisensory deficit

A

Brainstem lesion

174
Q

Cn exit

A

Cerebral - CN I and Il
Midbrain - CN Ill and IV
Pons - CN V, VI, VII and VIII Medulla - CN IX, X, XI, XII

175
Q

Central facial palsy

A

Paralysis of lower half of face
• Lesion in the contralateral motor cortex or corticobulbar tract

176
Q

• Spastic gait disorder
• Bilateral corticospinal signs, with or without bladder symptoms
• Cutaneous sensory loss / sensory
level

A

Spinal cord lesion

177
Q

Plexus roots

A

Brachial Plexus - C5-1 roots
• Lumbosacral Plexus - L1-S2

178
Q

Peripheral n. Lesion

A

Weakness
Distal, symmetrical

Sensory deficits
Distal, symmetrical

Autonomic disturbances
May be present

Reflexes
Areflexia

179
Q

Muscle dysfunction

A

Weakness
Proximal, symmetrical

Objective sensory deficits
None

Autonomic disturbances
None

Reflexes
Depending on severity of weakness

180
Q

Nmj dysfunction

A

Motor dysfunction
Predilection for motor cranial nerves
Proximal
fluctuating weaknes

Sensory dysfunction
None

Autonomic dysfunction
None

Reflexes
Normal

181
Q

The most frequent neurologic disease with sudden onset and rapid course of neurologic deficit:

A

Cerebrovascular disease

182
Q

The most frequent neurologic disease with insidious onset and slowly progressive course of neurologic deficits:

A

Mass lesion
Degenerative disease

183
Q

Neurologic disease that may be acute, subacute or chronic:

A

A. Infection
B. Metabolic/endocrine
C. Intoxication
D. Demyelinating disease

184
Q

Increased tone -

185
Q

Abnormal involuntary movements

A

Dyskinesia

186
Q

Clasp-knife phenomenon in hemiplegic, quadriplegic, monoplegic, or paraplegic distribution
The examiner elicits the clasp-knife phenomenon, a catch-and-yiekl sensation, by a quick jerk of the resting extremity
Clonus and hyperactive MSRs
Extensor toe sign
Tends to predominate in one set of muscles, such as flexors of the upper extremity, the extensors of the knee, and plantar flexors of the ankle
EMG inactive with the muscle at complete rest

A

Spasticity
Pyramidal

187
Q

Lead-pipe phenomenon, often with cogwheeling and tremor at rest; usually in all four extremities but may have a “hemi” distribution The examiner elicits the lead-pipe phenomenon of rigidity by making a relatively slow movement of the patient’s resting extremity
No clonus; MSRs not necessarily altered
Normal plantar reflexes
Tends to affect antagonistic pairs of muscles about equally
EMG tends to show electrical activity with the muscle as relaxed as the patient can make it

A

Rigidity
Extrapyramidal

188
Q

Ipsilateral limb ataxia
• Intention tremor
• Dysmetria
• Dysdiadochokinesia

A

Cerebellar hemisphere lesion

189
Q

Truncal ataxia
• No limb ataxia

A

Cerebellar vermis ataxia

Medsurg (8 decks)

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